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Shah M, El Chaer F, Ho DY, El Boghdadly Z. Managing infectious challenges in the age of molecular-targeted therapies for adult hematological malignancies. Transpl Infect Dis 2024; 26:e14283. [PMID: 38698640 DOI: 10.1111/tid.14283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 03/15/2024] [Accepted: 04/02/2024] [Indexed: 05/05/2024]
Abstract
Over the last decade, the therapeutic landscape for hematological malignancies (HMs) has witnessed a remarkable surge in the development of novel biological and small-molecule-targeted immunomodulatory agents. These therapies have drastically improved survival, but some come at the cost of increased risk of bacterial, viral, and/or fungal infections and on-target off-tumor immunological side effects. To mitigate such risks, physicians must be well informed about infectious complications and necessary preventive measures, such as screening, vaccinations, and antimicrobial prophylaxis. Furthermore, physicians should be vigilant about the noninfectious side effects of these agents that can mimic infections and understand their potential drug-drug interactions with antimicrobials. Strengthening and harmonizing the current surveillance and reporting system for drug-associated infections in real-world settings is essential to better ascertain the potential infections associated with these agents. In this review, we aimed to summarize the infection risks associated with novel agents used for specific HMs and outline recommended strategies for monitoring and prophylaxis.
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Affiliation(s)
- Manan Shah
- Division of Hematology and Medical Oncology, Department of Internal Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Firas El Chaer
- Division of Hematology and Oncology, Department of Medicine, The University of Virginia, Charlottesville, Virginia, USA
| | - Dora Y Ho
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University, Stanford, Virginia, USA
| | - Zeinab El Boghdadly
- Division of Infectious Diseases, Department of Internal Medicine, The Ohio State University, Columbus, Ohio, USA
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2
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Teh BW, Mikulska M, Mueller NJ, Slavin MA. Goals to score: The need for a minimum reporting dataset in studies of infection events in immunocompromised patients. Transpl Infect Dis 2024; 26:e14154. [PMID: 37707306 DOI: 10.1111/tid.14154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 09/06/2023] [Accepted: 09/06/2023] [Indexed: 09/15/2023]
Affiliation(s)
- Benjamin W Teh
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Australia
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Malgorzata Mikulska
- Division of Infectious Diseases, Department of Health Sciences, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Nicolas J Mueller
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zürich, Zurich, Switzerland
| | - Monica A Slavin
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Australia
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Australia
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3
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Teh BW, Mikulska M, Averbuch D, de la Camara R, Hirsch HH, Akova M, Ostrosky-Zeichner L, Baddley JW, Tan BH, Mularoni A, Subramanian AK, La Hoz RM, Marinelli T, Boan P, Aguado JM, Grossi PA, Maertens J, Mueller NJ, Slavin MA. Consensus position statement on advancing the standardised reporting of infection events in immunocompromised patients. THE LANCET. INFECTIOUS DISEASES 2024; 24:e59-e68. [PMID: 37683684 DOI: 10.1016/s1473-3099(23)00377-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 06/07/2023] [Accepted: 06/09/2023] [Indexed: 09/10/2023]
Abstract
Patients can be immunocompromised from a diverse range of disease and treatment factors, including malignancies, autoimmune disorders and their treatments, and organ and stem-cell transplantation. Infections are a leading cause of morbidity and mortality in immunocompromised patients, and the disease treatment landscape is continually evolving. Despite being a critical but preventable and curable adverse event, the reporting of infection events in randomised trials lacks sufficient detail while inconsistency of categorisation and definition of infections in observational and registry studies limits comparability and future pooling of data. A core reporting dataset consisting of category, site, severity, organism, and endpoints was developed as a minimum standard for reporting of infection events in immunocompromised patients across study types. Further additional information is recommended depending on study type. The standardised reporting of infectious events and attributable complications in immunocompromised patients will improve diagnostic, treatment, and prevention approaches and facilitate future research in this patient group.
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Affiliation(s)
- Benjamin W Teh
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, VIC, Australia.
| | - Malgorzata Mikulska
- Division of Infectious Diseases, Department of Health Sciences, University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Dina Averbuch
- Pediatric Infectious Diseases, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel; Hadassah Medical Center, Jerusalem, Israel
| | | | - Hans H Hirsch
- Transplantation & Clinical Virology, Department of Biomedicine, University of Basel, Basel, Switzerland; Infectious Diseases & Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
| | - Murat Akova
- Department of Infectious Diseases, Hacettepe University School of Medicine, Ankara, Turkey
| | - Luis Ostrosky-Zeichner
- Division of Infectious Diseases, McGovern Medical School, University of Texas, Houston, TX, USA
| | - John W Baddley
- Department of Medicine, Division of Infectious Diseases, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Ban Hock Tan
- Department of Infectious Diseases, Singapore General Hospital, Singapore
| | - Alessandra Mularoni
- Department of Infectious Diseases, Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione (IRCCS), Palermo, Italy
| | - Aruna K Subramanian
- Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Ricardo M La Hoz
- Division of Infectious Diseases and Geographic Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Tina Marinelli
- Department of Infectious Diseases, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Peter Boan
- Department of Infectious Diseases, Fiona Stanley Hospital, Murdoch, WA, Australia; Department of Microbiology, PathWest Laboratory Medicine WA, Fiona Stanley Hospital, Murdoch, WA, Australia
| | - Jose Maria Aguado
- Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Sanitaria Hospital "12 de Octubre" (imas12), CIBERINFEC, Universidad Complutense, Madrid, Spain
| | - Paolo A Grossi
- Infectious and Tropical Diseases Unit, Department of Medicine and Surgery, University of Insubria-ASST-Sette Laghi, Varese, Italy
| | - Johan Maertens
- Department of Haematology, Universitaire Ziekenhuizen Leuven, Leuven, Belgium
| | - Nicolas J Mueller
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zürich, Switzerland
| | - Monica A Slavin
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, VIC, Australia; Victorian Infectious Diseases Service, Royal Melbourne Hospital, Parkville, VIC, Australia
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4
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Yang Y, Li J, Huang S, Li J, Yang S. Impact of Infection Patterns on the Outcomes of Patients with Hematological Malignancies in Southwest China: A 10-Year Retrospective Case-Control Study. Infect Drug Resist 2023; 16:3659-3669. [PMID: 37313262 PMCID: PMC10259580 DOI: 10.2147/idr.s404927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 05/25/2023] [Indexed: 06/15/2023] Open
Abstract
Background This study aimed to assess the effect of infection patterns on the outcomes of patients with hematological malignancies (HM) and to identify the determinants of in-hospital mortality. Methods A case-control study was retrospectively conducted in a tertiary teaching hospital in Chongqing, Southwest China from 2011 to 2020. Clinical characteristics, microbial findings, and outcomes of HM patients with infections were retrieved from the hospital information system. Chi-square or Fisher's exact test was adopted to test the significance of mortality rate. Kaplan-Meier survival analysis and Log rank test were applied to evaluate and compare the 30-day survival rates of those groups. Binary logistic regression, Cox proportional hazards regression, and receiver operating characteristic curves were used to investigate the determinants of in-hospital mortality. Results Of 1,570 enrolled participants, 43.63% suffered from acute myeloid leukemia, 69.62% received chemotherapy, and 25.73% had hematopoietic stem cell transplantation (HSCT). Microbial infection was documented in 83.38% of participants. Co-infection and septic shock were reported in 32.87% and 5.67% of participants, respectively. Patients with septic shock suffered a significantly lower 30-day survival rate, while those with distinct types of pathogens or co-infections had a comparable 30-day survival rate. The all-cause in-hospital mortality was 7.01% and higher mortality rate was observed in patients with allo-HSCT (7.20%), co-infection (9.88%), and septic shock (33.71%). Cox proportional hazards regression illustrated that elderly age, septic shock, and elevated procalcitonin (PCT) were independent predictors of in-hospital mortality. A PCT cut-off value of 0.24 ng/mL predicted in-hospital mortality with a sensitivity of 77.45% and a specificity of 59.80% (95% CI = 0.684-0.779, P<0.0001). Conclusion Distinct infectious patterns of HM inpatients were previously unreported in Southwest China. It was the severity of infection, not co-infection, source of infection, or type of causative pathogen that positively related to poor outcome. PCT guided early recognition and treatment of septic shock were advocated.
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Affiliation(s)
- Yali Yang
- Department of Laboratory Medicine, the First Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
| | - Junjie Li
- Key Laboratory of Laboratory Medical Diagnostics, Ministry of Education, Department of Laboratory Medicine, Chongqing Medical University, Chongqing, People’s Republic of China
| | - Shifeng Huang
- Department of Laboratory Medicine, the First Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
| | - Junnan Li
- Department of Hematology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
| | - Shuangshuang Yang
- Department of Laboratory Medicine, the First Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
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Andreescu M. Risk of Infections Secondary to the Use of Targeted Therapies in Hematological Malignancies. Life (Basel) 2023; 13:1272. [PMID: 37374055 DOI: 10.3390/life13061272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 05/24/2023] [Accepted: 05/27/2023] [Indexed: 06/29/2023] Open
Abstract
Concurrent infections in hematological malignancies (HM) are major contributors to adverse clinical outcomes, including prolonged hospitalization and reduced life expectancy. Individuals diagnosed with HM are particularly susceptible to infectious pathogens due to immunosuppression, which can either be inherent to the hematological disorder or induced by specific therapeutic strategies. Over the years, the treatment paradigm for HM has witnessed a tremendous shift, from broad-spectrum treatment approaches to more specific targeted therapies. At present, the therapeutic landscape of HM is constantly evolving due to the advent of novel targeted therapies and the enhanced utilization of these agents for treatment purposes. By initiating unique molecular pathways, these agents hinder the proliferation of malignant cells, consequently affecting innate and adaptive immunity, which increases the risk of infectious complications. Due to the complexity of novel targeted therapies and their associated risks of infection, it often becomes a daunting task for physicians to maintain updated knowledge in their clinical practice. The situation is further aggravated by the fact that most of the initial clinical trials on targeted therapies provide inadequate information to determine the associated risk of infection. In such a scenario, a cumulative body of evidence is paramount in guiding clinicians regarding the infectious complications that can arise following targeted therapies. In this review, I summarize the recent knowledge on infectious complications arising in the context of targeted therapies for HM.
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Affiliation(s)
- Mihaela Andreescu
- Department of Clinical Sciences, Hematology, Faculty of Medicine, Titu Maiorescu University of Bucharest, 040051 Bucharest, Romania
- Department of Hematology, Colentina Clinical Hospital, 020125 Bucharest, Romania
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6
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Sweeney DA, Tuyishimire B, Ahuja N, Beigel JH, Beresnev T, Cantos VD, Castro JG, Cohen SH, Cross K, Dodd LE, Erdmann N, Fung M, Ghazaryan V, George SL, Grimes KA, Hynes NA, Julian KG, Kandiah S, Kim HJ, Levine CB, Lindholm DA, Lye DC, Maves RC, Oh MD, Paules C, Rapaka RR, Short WR, Tomashek KM, Wolfe CR, Kalil AC. Baricitinib Treatment of Coronavirus Disease 2019 Is Associated With a Reduction in Secondary Infections. Open Forum Infect Dis 2023; 10:ofad205. [PMID: 37206623 PMCID: PMC10191442 DOI: 10.1093/ofid/ofad205] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 04/13/2023] [Indexed: 05/21/2023] Open
Abstract
We performed a secondary analysis of the National Institutes of Health-sponsored Adaptive COVID-19 Treatment Trial (ACTT-2) randomized controlled trial and found that baricitinib was associated with a 50% reduction in secondary infections after controlling for baseline and postrandomization patient characteristics. This finding provides a novel mechanism of benefit for baricitinib and supports the safety profile of this immunomodulator for the treatment of coronavirus disease 2019.
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Affiliation(s)
- Daniel A Sweeney
- Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | | | - Neera Ahuja
- Department of Medicine, Stanford University, Palo Alto, CA, USA
| | - John H Beigel
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Tatiana Beresnev
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | | | - Jose G Castro
- Department of Medicine, University of Miami, Miami, FL, USA
| | - Stuart H Cohen
- Department of Internal Medicine, University of California Davis, Sacramento, CA, USA
| | | | - Lori E Dodd
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Nathan Erdmann
- Department of Medicine, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | - Monica Fung
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Varduhi Ghazaryan
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Sarah L George
- Department of Medicine, Saint Louis University and St. Louis VA Medical Center, Saint Louis, MO, USA
| | - Kevin A Grimes
- Department of Medicine, Houston Methodist, Houston, TX, USA
| | - Noreen A Hynes
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kathleen G Julian
- Department of Medicine, Pennsylvania State Health Milton S. Hershey Medical Center, Hershey, PA, USA
| | | | - Hannah Jang Kim
- Community Health Systems Department, University of California San Francisco, San Francisco, CA, USA
- Department of Nursing, Kaiser Permanente National Patient Care Services, Oakland, CA, USA
| | - Corri B Levine
- Department of Internal Medicine Galveston, University of Texas Medical Branch, TX, USA
| | - David A Lindholm
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
- Department of Medicine, Brooke Army Medical Center, Joint Base San Antonio-Ft Sam Houston, TX, USA
| | - David C Lye
- National Centre for Infectious Diseases, Singapore, Singapore
- Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore, Singapore
- Lee Kong Chian School of Medicine, Singapore, Singapore
- Yong Loo Lin School of Medicine, Singapore, Singapore
| | - Ryan C Maves
- Departments of Internal Medicine and Anesthesiology, Wake Forest University, Winston-Salem, NC, USA
| | - Myoung-don Oh
- Department of Internal Medicine, Seoul National University Hospital College of Medicine, Seoul, Korea
| | - Catharine Paules
- Department of Medicine, Pennsylvania State Health Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Rekha R Rapaka
- Department of Medicine, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Willam R Short
- Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Kay M Tomashek
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | | | - Andre C Kalil
- Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, USA
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Cliff ERS, Reynolds G, Popat R, Teh BW, Kesselheim AS, Mohyuddin GR. Acknowledging Infection Risk in Bispecific Antibody Trials in the Treatment of Multiple Myeloma. J Clin Oncol 2023; 41:1949-1951. [PMID: 36716411 DOI: 10.1200/jco.22.02197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 12/08/2022] [Indexed: 02/01/2023] Open
Affiliation(s)
- Edward R Scheffer Cliff
- Edward R. Scheffer Cliff, MBBS, MPH, Program on Regulation, Therapeutics and Law, Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Gemma Reynolds, MChD, MIDI, National Center for Infections in Cancer, Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia, Department of Infectious Diseases, Austin Health, Heidelberg, Melbourne, Victoria, Australia; Rakesh Popat, MBBS, PhD, NIHR UCLH Clinical Research Facility, University College London Hospitals, NHS Foundation Trust, London, United Kingdom; Benjamin W. Teh, MBBS, PhD, National Center for Infections in Cancer, Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia, Sir Peter MacCallum Department of Oncology, University of Melbourne, Victoria, Australia; Aaron S. Kesselheim, MD, JD, MPH, Program on Regulation, Therapeutics and Law, Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; and Ghulam Rehman Mohyuddin, MBBS, Division of Hematology and Hematological Malignancies, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Gemma Reynolds
- Edward R. Scheffer Cliff, MBBS, MPH, Program on Regulation, Therapeutics and Law, Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Gemma Reynolds, MChD, MIDI, National Center for Infections in Cancer, Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia, Department of Infectious Diseases, Austin Health, Heidelberg, Melbourne, Victoria, Australia; Rakesh Popat, MBBS, PhD, NIHR UCLH Clinical Research Facility, University College London Hospitals, NHS Foundation Trust, London, United Kingdom; Benjamin W. Teh, MBBS, PhD, National Center for Infections in Cancer, Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia, Sir Peter MacCallum Department of Oncology, University of Melbourne, Victoria, Australia; Aaron S. Kesselheim, MD, JD, MPH, Program on Regulation, Therapeutics and Law, Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; and Ghulam Rehman Mohyuddin, MBBS, Division of Hematology and Hematological Malignancies, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Rakesh Popat
- Edward R. Scheffer Cliff, MBBS, MPH, Program on Regulation, Therapeutics and Law, Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Gemma Reynolds, MChD, MIDI, National Center for Infections in Cancer, Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia, Department of Infectious Diseases, Austin Health, Heidelberg, Melbourne, Victoria, Australia; Rakesh Popat, MBBS, PhD, NIHR UCLH Clinical Research Facility, University College London Hospitals, NHS Foundation Trust, London, United Kingdom; Benjamin W. Teh, MBBS, PhD, National Center for Infections in Cancer, Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia, Sir Peter MacCallum Department of Oncology, University of Melbourne, Victoria, Australia; Aaron S. Kesselheim, MD, JD, MPH, Program on Regulation, Therapeutics and Law, Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; and Ghulam Rehman Mohyuddin, MBBS, Division of Hematology and Hematological Malignancies, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Benjamin W Teh
- Edward R. Scheffer Cliff, MBBS, MPH, Program on Regulation, Therapeutics and Law, Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Gemma Reynolds, MChD, MIDI, National Center for Infections in Cancer, Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia, Department of Infectious Diseases, Austin Health, Heidelberg, Melbourne, Victoria, Australia; Rakesh Popat, MBBS, PhD, NIHR UCLH Clinical Research Facility, University College London Hospitals, NHS Foundation Trust, London, United Kingdom; Benjamin W. Teh, MBBS, PhD, National Center for Infections in Cancer, Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia, Sir Peter MacCallum Department of Oncology, University of Melbourne, Victoria, Australia; Aaron S. Kesselheim, MD, JD, MPH, Program on Regulation, Therapeutics and Law, Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; and Ghulam Rehman Mohyuddin, MBBS, Division of Hematology and Hematological Malignancies, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Aaron S Kesselheim
- Edward R. Scheffer Cliff, MBBS, MPH, Program on Regulation, Therapeutics and Law, Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Gemma Reynolds, MChD, MIDI, National Center for Infections in Cancer, Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia, Department of Infectious Diseases, Austin Health, Heidelberg, Melbourne, Victoria, Australia; Rakesh Popat, MBBS, PhD, NIHR UCLH Clinical Research Facility, University College London Hospitals, NHS Foundation Trust, London, United Kingdom; Benjamin W. Teh, MBBS, PhD, National Center for Infections in Cancer, Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia, Sir Peter MacCallum Department of Oncology, University of Melbourne, Victoria, Australia; Aaron S. Kesselheim, MD, JD, MPH, Program on Regulation, Therapeutics and Law, Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; and Ghulam Rehman Mohyuddin, MBBS, Division of Hematology and Hematological Malignancies, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Ghulam Rehman Mohyuddin
- Edward R. Scheffer Cliff, MBBS, MPH, Program on Regulation, Therapeutics and Law, Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Gemma Reynolds, MChD, MIDI, National Center for Infections in Cancer, Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia, Department of Infectious Diseases, Austin Health, Heidelberg, Melbourne, Victoria, Australia; Rakesh Popat, MBBS, PhD, NIHR UCLH Clinical Research Facility, University College London Hospitals, NHS Foundation Trust, London, United Kingdom; Benjamin W. Teh, MBBS, PhD, National Center for Infections in Cancer, Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia, Sir Peter MacCallum Department of Oncology, University of Melbourne, Victoria, Australia; Aaron S. Kesselheim, MD, JD, MPH, Program on Regulation, Therapeutics and Law, Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; and Ghulam Rehman Mohyuddin, MBBS, Division of Hematology and Hematological Malignancies, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
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8
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Telli Dizman G, Aguado JM, Fernández-Ruiz M. Risk of infection in patients with hematological malignancies receiving CAR T-cell therapy: systematic review and meta-analysis. Expert Rev Anti Infect Ther 2022; 20:1455-1476. [PMID: 36148506 DOI: 10.1080/14787210.2022.2128762] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Chimeric antigen receptor (CAR) T-cell therapy has emerged as a promising treatment option for relapsed or refractory B-cell malignancies and multiple myeloma. Underlying and treatment-related variables may contribute to the development of infectious complications. RESEARCH DESIGN AND METHODS We conducted a systematic review and meta-analysis on the incidence of overall and severe (grade ≥3) infection in patients with hematological malignancies receiving CAR T-cells. Secondary outcomes included the specific rates of bacterial, viral and invasive fungal infection (IFI), and infection-related mortality. PubMed, Embase and Web of Science databases were searched from inception to 27 May 2022. Sensitivity analysis were performed according to the type of malignancy and study design (randomized clinical trials [RCTs] or observational studies). RESULTS Forty-five studies (34 RCTs) comprising 3,591 patients were included. The pooled incidence rates of overall and severe infection were 33.8% (I2 = 96.31%) and 16.2% (I2 = 74.41%). The respiratory tract was the most common site of infection. Most events were bacterial or viral, whereas the occurrence of IFI was rare. The pooled attributable mortality was 1.8% (I2 = 43.44%). CONCLUSIONS Infection is a frequent adverse event in patients receiving CAR T-cell therapy. Further research should address specific risk factors in this population.
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Affiliation(s)
- Gülçin Telli Dizman
- Department of Infectious Disease and Clinical Microbiology, Hacettepe University School of Medicine, Ankara, Turkey
| | - José María Aguado
- Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Sanitaria Hospital "12 de Octubre" (imas12), Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III (ISCIII), Madrid, Spain.,Department of Medicine, School of Medicine, Universidad Complutense, Madrid, Spain
| | - Mario Fernández-Ruiz
- Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Sanitaria Hospital "12 de Octubre" (imas12), Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III (ISCIII), Madrid, Spain.,Department of Medicine, School of Medicine, Universidad Complutense, Madrid, Spain
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9
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Avni T, Leibovici L, Cohen I, Atamna A, Guz D, Paul M, Gafter-Gvili A, Yahav D. Tocilizumab in the treatment of COVID-19-a meta-analysis. QJM 2021; 114:577-586. [PMID: 34010403 PMCID: PMC8243364 DOI: 10.1093/qjmed/hcab142] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 05/05/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Interleukin-6 inhibitors showed promising results in observational trials of patients with coronavirus disease 2019 (COVID-19). AIM To evaluate whether interleukin-6 inhibitor tocilizumab (TCZ) reduces mortality among hospitalized COVID-19 patients. DESIGN A systematic review and meta-analysis. METHODS Systematic review and meta-analysis of randomized controlled trials (RCTs) comparing TCZ vs. placebo/control, for treatment of adults with COVID-19. Primary outcome was 28-30 days all-cause mortality. Search was conducted up to 1 April 2021. Two independent reviewers screened citations, extracted data and assessed risk of bias. Relative risk (RR) with 95% confidence intervals (CI) were pooled. We performed subgroup analysis for patients with critical illness and sensitivity analyses. RESULTS Eight RCTs were included, assessing 6481 patients with mostly severe non-critical COVID-19 infection. TCZ was associated with a reduction in all-cause 28-30-day mortality compared to placebo/control (RR = 0.89, 95% CI 0.82-0.96). Among the subgroup of critically ill patients no reduced mortality was demonstrated (RR = 0.94, 95% CI 0.74-1.19). No mortality benefit with TCZ was demonstrated in trials that used steroids for >80% of patients. TCZ was associated with significantly reduced risk for mechanical ventilation (MV); for combined endpoint of death or MV and for intensive care unit (ICU) admission. No significant difference in adverse events was demonstrated. Risk of serious superinfection was significantly lower with TCZ (RR = 0.57, 95% CI 0.35-0.93). CONCLUSION The treatment with TCZ reduces 28-30 days all-cause mortality, ICU admission, superinfections, MV and the combined endpoint of death or MV. Among critically ill patients, and when steroids were used for most patients, no mortality benefit was demonstrated. Additional research should further define sub-groups that would benefit most and preferred timing of administration of TCZ in severe COVID-19.
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Affiliation(s)
- Tomer Avni
- Medicine A
- Unit of Infectious Diseases
- Sackler Faculty of Medicine, Tel-Aviv
University, Israel
- Corresponding
author: Tomer Avni, MD. Medicine A, Rabin
Medical Center, Beilinson Hospital, 39 Jabotinsky Road, Petah-Tikva 49100,
Israel. Tel. +972-3-9377116;
| | - Leonard Leibovici
- Research Authority, Rabin Medical Center, Beilinson
Hospital
- Sackler Faculty of Medicine, Tel-Aviv
University, Israel
| | - Ido Cohen
- Sackler Faculty of Medicine, Tel-Aviv
University, Israel
| | - Alaa Atamna
- Unit of Infectious Diseases
- Sackler Faculty of Medicine, Tel-Aviv
University, Israel
| | | | - Mical Paul
- Infectious diseases Unit, Rambam Health Care Campus and Rappaport
Faculty of Medicine, Technion—Israel Institute of
Technology, Haifa, Israel
| | | | - Dafna Yahav
- Unit of Infectious Diseases
- Sackler Faculty of Medicine, Tel-Aviv
University, Israel
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10
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Chemaly RF. The ever-growing world of infections in immunocompromised patients: major headways with numerous shortcomings. Clin Microbiol Infect 2021; 27:1379-1380. [PMID: 34256140 DOI: 10.1016/j.cmi.2021.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 07/01/2021] [Indexed: 11/17/2022]
Affiliation(s)
- Roy F Chemaly
- Department of Infectious Diseases, Infection Control, and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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11
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Infectious Challenges with Novel Antibody–Based Therapies. Curr Infect Dis Rep 2021. [DOI: 10.1007/s11908-021-00753-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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12
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Ruiz-Camps I, Aguilar-Company J. Risk of infection associated with targeted therapies for solid organ and hematological malignancies. Ther Adv Infect Dis 2021; 8:2049936121989548. [PMID: 33680453 PMCID: PMC7897815 DOI: 10.1177/2049936121989548] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 12/26/2020] [Indexed: 12/15/2022] Open
Abstract
Higher risks of infection are associated with some targeted drugs used to treat solid organ and hematological malignancies, and an individual patient’s risk of infection is strongly influenced by underlying diseases and concomitant or prior treatments. This review focuses on risk levels and specific suggestions for management, analyzing groups of agents associated with a significant effect on the risk of infection. Due to limited clinical experience and ongoing advances in these therapies, recommendations may be revised in the near future. Bruton tyrosine kinase (BTK) inhibitors are associated with a higher rate of infections, including invasive fungal infection, especially in the first months of treatment and in patients with advanced, pretreated disease. Phosphatidylinositol 3-kinase (PI3K) inhibitors are associated with an increased risk of Pneumocystis pneumonia and cytomegalovirus (CMV) reactivation. Venetoclax is associated with cytopenias, respiratory infections, and fever and neutropenia. Janus kinase (JAK) inhibitors may predispose patients to opportunistic and fungal infections; need for prophylaxis should be assessed on an individual basis. Mammalian target of rapamycin (mTOR) inhibitors have been linked to a higher risk of general and opportunistic infections. Breakpoint cluster region-Abelson (BCR-ABL) inhibitors are associated with neutropenia, especially over the first months of treatment. Anti-CD20 agents may cause defects in the adaptative immune response, hypogammaglobulinemia, neutropenia, and hepatitis B reactivation. Alemtuzumab is associated with profound and long-lasting immunosuppression; screening is recommended for latent infections and prevention strategies against CMV, herpesvirus, and Pneumocystis infections. Checkpoint inhibitors (CIs) may cause immune-related adverse events for which prolonged treatment with corticosteroids is needed: prophylaxis against Pneumocystis is recommended.
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Affiliation(s)
- Isabel Ruiz-Camps
- Infectious Diseases Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Juan Aguilar-Company
- Infectious Diseases Department and Oncology Department, Vall d'Hebron University Hospital, Barcelona, Spain
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13
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Cordonnier C, Maschmeyer G, Cesaro S, Ljungman P. Reporting infectious complications in haematology clinical trials should be improved. Clin Microbiol Infect 2019; 25:1451-1453. [DOI: 10.1016/j.cmi.2019.07.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 07/28/2019] [Accepted: 07/28/2019] [Indexed: 12/16/2022]
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